Obesity: It’s time to compromise and meet in the middle

Among the more contentious issues regarding health and weight control — perhaps surprisingly, contentious among professionals and the general public alike — is the role of personal responsibility. Unfortunately, this readily devolves into discord, because the cultural tendency of our time is denigrate those with whom we disagree, and hunker down in our distal, opposing corner. Just take a look at Congress to see how well this is working out for us!

There is, of course, a better way: listening to one another. Considering that the truth might be somewhere in the middle, informed by insights from both corners. And suddenly, then, we are in opposing corners no more — but on common ground, with common cause, and making what has become all too uncommon: actual progress.

Before making that case, let’s pause long enough to consider the implications for personal responsibility. If we are going into the water, it makes sense that we first know how to swim. It makes sense that a parent on the beach would watch their own child with great vigilance. It makes sense that families would keep watch over their backyard pools. And it makes sense that we would put on life preservers while white-water rafting. So far, this sounds like a pretty hefty dose of personal responsibility.

But then again, it also makes sense that we have lifeguards at the beach. It makes sense that we put fences around pools. It makes sense that if someone falls into the water and can’t swim, someone who can rushes in to help.

It also makes sense that we don’t run advertisements at the beach encouraging swimmers to try their luck with the most dangerous riptides. It makes sense that we don’t goad our neighbors’ children into the deep end of a pool before making sure they can swim. It makes sense that the body politic and culture don’t conspire to make people drown.

All of this would make exactly comparable sense in the management of weight, and health. There, too, a blend of personal responsibility and public empowerment could help us all add years to life and life to years, while wearing clothes in the size we prefer along the way. But we don’t do this. We act as if we should be debating between parental vigilance and lifeguards; swimming lessons or fences around pools. Why preclude the choice of choosing both?

Now to my principal argument: obesity is just like drowning. We have been told by Michael Moss, and others before him, that our food supply is willfully manipulated by smart and highly trained people to maximize the eating we all do, the calories it takes to feel full, and — of course — the money we spend along the way. As a species, we have no native defenses against caloric excess in the first place, never having needed them before. Couple that with a food supply engineered to ensure that we “can’t eat just one,” and we all are primed to drown in calories.

Similarly, we have no native defenses against the lure of the couch, either. For the most part, animals in nature will lounge when they can; the demands of survival limit how often that is. But the demands of survival are mostly met with technology now, so we can lounge all but limitlessly. We are drowning in labor-saving technology, too.

Responsibility for all of this resides squarely in the middle, between those opposing corners. Nobody is going to eat well on our behalf; nobody is going to exercise for us. But how much sense does it make to acknowledge far and wide the calamitous effects of childhood obesity, yet continue to peddle multi-colored marshmallows to 6-year-olds as “part of a complete breakfast”? That’s exactly analogous to holding people accountable for their own swimming, yet actively encouraging them to try out those riptides. It is, in a word- idiotic. And in another word: hypocritical. With regard to weight and health, America runs on constant hypocrisy.

And, of course, thinking of obesity as a variant on the theme of drowning (i.e., drowning type 1 = in water; drowning type 2 = in calories and labor-saving technology) also solves the problem of according it medical legitimacy without the need to label it a disease. That, in fact, was the focus of my editorial in Childhood Obesity. If obesity is a disease — a proclamation made during the past year by the American Medical Association — then all of our obese children are, suddenly, “diseased.” As a parent, grandparent, or reasonable adult looking on — are you really okay with that? I’m not.

I’m not because sometimes adults and kids can be heavy and healthy. I’m not because sometimes adults and kids can have the metabolic profile of obesity despite a normal weight or body-mass index. And I’m not because a disease implies something is wrong with the affected bodies.

But nothing is wrong with a body that drowns other than staying underwater too long: Normal, healthy human beings drown if they stay under water too long. Normal, healthy human beings get fat if they stay in our obesogenic culture too long, too. As we export our diet and lifestyle around the world, we see just how universal this vulnerability is.

And finally, the treatment of diseases emphasizes the medical system, drugs and procedures. Is that really where we want the focus to be when the problem is one of bodies behaving normally in an abnormally obesogenic environment? If so, we might also seek to develop drugs to treat drowning — while removing the fences from around pools, the lifeguards from the beaches, and never bothering to teach anyone to swim. We could throw one another to the sharks while we’re at it.

Come on folks, do we really want to be as dysfunctional as our Congress? Let’s meet in the middle, and acknowledge that bodies fare best when self-care and the actions of the body politic are aligned rather than in battle.

Obesity is, in many ways that matter most, analogous to drowning. Individuals can, and for the most part should, learn to “swim” through our obesogenic culture. But those swimming lessons need to be accessible, affordable, applicable and actionable. Meanwhile, responsibility for and scrutiny of the water’s edge should be a job not just for each one of us — but for all of us.

Physician Coaching by KevinMD

Obesity: It’s time to compromise and meet in the middle 3 comments

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Patient Kit

I love this article. I’m tempted to ask my local Brooklyn YMCA, where I swim laps 5x a week and where I’ve witnessed countless kids learn to swim over the years (with both lifeguards and parents nearby), to publiclly post it. Maybe you should consider sending it yourself to the Y headquarters and asking them to consider distributing it to their entire network of Ys. I think your swimming analogy is excellent. I also wish more people would give up the rigid either/or attitude to solving problems. Compromise doesn’t have to be the dirty word it has become.

I think you’re right, as far as you go. My weight has gone up and down over the years, so I have opinions about what works and what doesn’t for the human body. I can spend 2 years swearing I will lose weight, and -somehow- it just doesn’t happen, despite tracking my weight every single day. Then all of a sudden it will. All of a sudden I am less hungry, less driven to eat. Sometimes that is because I contract a sickness that limits my appetite and I can -somehow- maintain the lower level of eating as I start feeling better. Sometimes I don’t know what the tipping point is. Your analogy to drowning resonates less with me than a possible analogy to any other addiction. There are drugs that can be given to block the effects of heroin, for example. It has always seemed to me that there should be a way to block the appetite that drives people to eat more than they need. So far such attempts have had more undesirable side effects than we can accept. Right now I am 20 pounds or more below my highest weight and if my stomach growls, that’s fine. I can easily ignore it. Why is it fine now and not 2 years ago? Somehow resetting set points? I don’t know. It strikes me that, as much as we discuss it, we really don’t know a lot about what drives people to eat as much as they do. When we emphasize personal responsibility to overweight people, I think we do them a disservice. As you say, animals will eat and lounge if that is an available option. But I’ve had years and years of happily being in good shape, swimming laps for 45 minutes every other day, and not being motivated in the least to overeat. Moving to a place where a pool is not available resulted in weight gain, not just from lack of exercise but from just plain eating too much. The two interact, of course. But I could see my relationship to food change. We need to understand the driving motivation better, because it strikes me as a complex biochemical influence on our behavior. Not so much a matter of choice.

Lynda Schwemmer

Beautifully argued; I love this analogy. I have fought against being overweight all my adult life. There have been seasons when I felt helpless and just drifted downstream. Occasionally I have had enough of a jolt to resist and try again. It is a multifaceted problem indeed, but I was always the one yielding to the Cheetos.